Women ages 50-64 were the highest users of GLP-1s for weight management in 2025, with 20% reporting current or past GLP-1 use, according to RAND American Life Panel research. Yet this population has been largely ignored in studies of the drugs' risks and benefits, noted the authors of a recent commentary.

This "striking disconnect" echoes decades of women being overlooked by medical research, wrote RAND staff members Katherine M. Rancaño and Shannon D. Donofry in their commentary. The dearth of evidence means that, for now at least, these women and their healthcare providers base treatment decisions on incomplete information.

"We're definitely using obesity medications in patients who are older more than we used to," mainly because of the health benefits," Carolyn Newberry, MD, associate professor of clinical medicine and director of GI nutrition, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York City, told Medscape Medical News.

"But we continue to underscore the need for data supporting use in these patient populations."

Even patients who seem like suitable candidates for the medications are not necessarily enthusiastic about taking them, creating a potential barrier to medical treatment, noted Courtney Younglove, MD, founder and medical director of Heartland Weight Loss in Overland Park, Kansas. 

Women who are in midlife now grew up immersed in the "diet culture," she told Medscape Medical News. "They were teenagers through the height of the low-fat, calorie-counting, SnackWell's, Jane Fonda, calories-in, calories-out revolution, and that became a foundational part of their identity."

Therefore, many of the women in her practice who are 50+ "are deeply married to the idea of calorie restriction/starvation as the solution to weight loss, and they struggle to think outside of that concept."

How the Body Responds

Because patients respond differently to weight-loss drugs, it's often difficult to prepare them or to manage expectations when initiating treatment.

In Newberry's experience, menopausal women do lose weight with GLP-1s, although losses might be less than those for younger women. Currently, there is no published research dealing with this issue, she said, but her team recently conducted a study on the topic currently under review by a journal.

"Our study did show that advancing age was a risk factor for less weight-loss potential with the medications, which I think makes sense because, as we get older, our resting basal metabolic rate slows down," she said. "So, we're burning fewer calories, we may be less active at baseline, and we may have other health problems contributing to changes in metabolism and digestion."

The goal of GLP-1 therapy isn't necessarily to get people to a normal BMI, but to reduce the visceral adiposity that's causing health problems, Newberry tells patients. "I say we may see lower weight loss, and that's okay. Our goal is to make sure it's a healthy weight loss, and that's why diet and exercise and other lifestyle changes are so important," she said.

Diana Thiara, MD, medical director of the Weight Management program, University of California San Francisco, told Medscape Medical News that she counsels women about the likelihood of losing more (or less) weight than reported in study data and about the importance of an individualized approach. "We should check in before each dose up-titration, because not everyone needs to be on the maximum dose strength," she said.

Younglove counsels her patients who are eager to try GLP-1s that the drugs don't magically cause the body to release stored fat. "For most people, they make the body feel different — less hunger, less food noise," she said. "Those changes usually make it easier for patients to adopt the lifestyle changes that result in weight loss such as eating less and eating better. The lifestyle changes are what truly cause weight loss, and the medication gives them the capacity/space to make them."

Women in the "diet culture" generation often come into her office "with the toxic idea that once they lose the weight, they are going to be a stronger, better, more disciplined person and won't need the medication anymore," said Younglove, who is a member of the board of directors of the Obesity Medical Association. "They stop the medication because of the magical thinking that they are now a different person. And the weight comes back on."

But by then, they've typically lost "quite a bit of lean mass," she said, and the regained weight is rarely muscle mass. "These patients end up where they started from, but with more fat mass and less muscle mass. They are often sicker and have a lower metabolism than when they started, making the next attempt even harder," she said. "And because diet culture taught us that regaining weight is a failure of willpower and/or motivation, they typically have a lot of shame that they 'failed.' But it's not failure — it's biology."

What Menopausal Women Need to Hear

The importance of lifestyle changes for healthy weight loss with GLP-1 therapy necessitates a holistic approach to patient care, Thiara said. "As we are helping with weight loss, we also want to make sure patients are eating nutritious foods, exercising and strength training, sleeping well, and so forth."

Patients who make lifestyle changes and stick with them typically see huge gains in overall health, quality of life, overall well-being, and often the amount of weight lost, Younglove said. "Typically, we can use only a small dose of medication with these patients — and many slowly transition off the medication after a time," she said. "This goes against the pharma narrative of 'medication for life.'"

But if patients are laser-focused on the number on the scale without regard to health and loss of lean mass, Younglove often takes away the medication. "That doesn't make me super popular, but my job is to provide solid medical care," she said.

Newberry, like Younglove, noted that although everyone loses fat and muscle with age, postmenopausal women may lose more muscle when significant weight is lost. "That makes it important to counsel them on adequate protein intake and resistance exercises to try to limit the loss, she said.

Newberry's patients in their 50s, 60s, and early 70s who have had success with holistic weight-loss strategies work with a dietitian in her institution, get more physically active, and they take a GLP-1, she said. "They do great, and we have a lot of success stories across the board."

Importantly, she does not take on postmenopausal women whose BMI is in the normal range and who don't have weight-related conditions. "I have a lot of postmenopausal women who have gained a little weight and they see on Instagram, 'Oh, if you've gained 5 pounds, you should be able to use a GLP-1 to lose that,'" she said. "Right now, I don't have any data to support using GLP-1s in that patient population, and I personally haven't brought them into my practice. I just don't use it if someone's not overweight or obese, doesn't meet the BMI criteria, or doesn't have diabetes or other metabolic disorders."

Studies Needed

Research on the use of weight-loss drugs among menopausal women is sparse and flawed because it doesn't take into account the way weight loss is approached in this population or patients' ability to sustain it long-term, Younglove said.

"Current evidence derives almost exclusively from retrospective, observational studies subject to multiple confounders, including selection bias, healthy-user effects, and unmeasured confounding that limits causal inference," she said.

While some evidence suggests that menopause hormonal therapy (MHT) may attenuate central fat accumulation and preserve favorable body composition, it is not indicated as a primary weight-loss intervention, Younglove wrote in her recently published clinical review of MHT and weight management.

Although recent observational data suggest potential synergies when MHT is combined with obesity medications, "the findings are limited and need to be validated in clinical trials," she said. "Without randomized assignment to MHT, it is impossible to determine whether observed differences reflect direct MHT effects or characteristics of women who choose to use MHT."

Several topics are ripe for future investigation, Newberry noted. Is there a difference in how older patients respond to GLP-1s? Are there different risks associated with the medications in older patients? Because weight gain in menopausal women may be visceral adiposity, should lower BMI thresholds be used to determine whether a GLP-1 has health benefits?

"I don't think we know answers to any of these questions," she said.

Younglove reported no conflicts of interest. Newberry reported being a consultant for Eli Lilly and Co, and Thiara reported being a member of scientific advisory boards for Novo Nordisk, Eli Lilly, and Boehringer Ingelheim. 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.